Abstract Details

Title Prognostication with Low-field Portable MRI: White Matter Hyperintensity Volume Predicts Early Outcomes after Acute Ischemic Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P5 - Poster Session 5 (11:45 AM-12:45 PM)

Poster/Presentation
Number 5-010

Objective To assess agreement between low-field portable MRI (pMRI) and conventional MRI (cMRI) white matter hyperintensity volumes (WMHv) and determine whether portable WMHv predicts outcome after acute ischemic stroke (AIS).

Background WMHv ascertained from cMRI is associated with higher AIS risk, greater severity, and worse outcome. Given cMRI’s logistical and financial constraints, pMRI may offer a practical, scalable alternative to cMRI.

Design/Methods We retrospectively analyzed pMRI scans with FLAIR sequences from AIS admissions (2019-2024) and used cMRI scans from the same hospitalization for validation. WMHv was quantified automatically using WMH-SynthSeg. Ordinal logistic models adjusted for age, sex, admission NIHSS, and vascular risk factors predicted discharge modified Rankin Scale (mRS) and disposition. A binary logistic regression with the same adjustments predicted 3-month mRS (poor outcome mRS>1). Analyses were performed using Python 3.9.6.

Results pMRI scans were obtained from 155 patients (mean age 64.4 ± 15, 59.4% male, 65.8% white, median NIHSS 9), 131 of whom received a cMRI (avg. 1.3 days pMRI-cMRI, 2.76 days LKW-pMRI, 2.04 days LKW-cMRI). Although pMRI WMHv correlated with cMRI (r=0.843, p<0.001), pMRI underestimated volumes by 12.3% on average (Bland-Altman 95% LOA -85.9-+61.4%). Log-transformed pMRI WMHv was a strong predictor of discharge mRS (OR 2.34, 95% CI 1.28-4.28, p=0.006) and discharge disposition (OR 2.12, 95% CI 1.10-4.11, p=0.026). Surprisingly, hyperlipidemia had lower adjusted odds of worse outcomes (e.g. mRS OR 0.358, 95% CI 0.179-0.720, p=0.003). In 76 patients with 3-month follow-up, WMHv did not predict 3-month mRS. Hypertension (OR 7.53, 95% CI 1.28-44.4, p=0.026) and diabetes (OR 7.00, 95% CI 1.078-45.4, p=0.041) were independently associated with 3-month outcomes. NIHSS was a strong predictor of all outcomes (e.g. discharge mRS OR 1.15, 95% CI 1.10-1.21, p<0.001).

Conclusions pMRI produced WMHv that closely tracked cMRI despite underestimation. pMRI-derived WMHv aids early outcome prediction, while 3-month outcomes are driven by stroke severity and vascular comorbidities.

Authors/Disclosures
Annabelle Shanks, BS PRESENTER	Ms. Shanks has nothing to disclose.
Hailey Brigger	Ms. Brigger has nothing to disclose.
Steph Maynez	Ms. Maynez has nothing to disclose.
Ian P. Johnson	Mr. Johnson has nothing to disclose.
Alison Champagne	Mrs. Champagne has nothing to disclose.
Gordon Sze	Gordon Sze has nothing to disclose.
Sam Payabvash	Sam Payabvash has nothing to disclose.
Jua Iglesias Gonzalez (Martinos Center for Biomedical Imaging)	Jua Iglesias Gonzalez has nothing to disclose.
Matthew Rosen	Matthew Rosen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for DeepSpin. Matthew Rosen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Chipiron. Matthew Rosen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Synex Medical. Matthew Rosen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Nanalysis. Matthew Rosen has stock in Hyperfine. Matthew Rosen has stock in Q Bio. Matthew Rosen has stock in Vizma Life Sciences. Matthew Rosen has stock in Intact Data Services. The institution of Matthew Rosen has received research support from Imagion. Matthew Rosen has received intellectual property interests from a discovery or technology relating to health care.
Annabel Sorby-Adams (Massachusetts General Hospital and Harvard Medical School)	Annabel Sorby-Adams has nothing to disclose.
W. T. Kimberly, MD, PhD (Massachusetts General Hospital)	Dr. Kimberly has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astrocyte Pharmaceuticals. Dr. Kimberly has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Acasti Pharma. Dr. Kimberly has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Takeda. Dr. Kimberly has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Stryker. Dr. Kimberly has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurotherapeutics. Dr. Kimberly has stock in Woolsey Pharmaceuticals. Dr. Kimberly has stock in Acasti Pharma. The institution of Dr. Kimberly has received research support from NIH. The institution of Dr. Kimberly has received research support from Hyperfine, Inc.. The institution of Dr. Kimberly has received research support from Alzheimer's Association. Dr. Kimberly has received intellectual property interests from a discovery or technology relating to health care.
Adam De Havenon, MD, FAAN (Yale University)	Dr. De Havenon has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novo Nordisk. Dr. De Havenon has or had stock in Certus.Dr. De Havenon has or had stock in TitinKM. The institution of Dr. De Havenon has received research support from NIH/NINDS. Dr. De Havenon has received publishing royalties from a publication relating to health care.
Kevin N. Sheth, MD, FAAN (Yale UniversityDivision of Neuro and Critical Care)	Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. Dr. Sheth has received stock or an ownership interest from Astrocyte. Dr. Sheth has received stock or an ownership interest from Alva. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care.

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